What causes shoulder pain and what can you do about it?

The shoulder is made up of various joints and tendons that allow a huge range of motion, allowing you to shrug your shoulders up and down and reach behind your back and in front of you. Many of us don’t realise how much movement our shoulders enable until something goes wrong. Then, it can severely limit mobility and cause searing shoulder pain.

But what causes shoulder pain, and what treatments are available?

How common is shoulder pain?

Shoulder pain is extremely common. A sports injury, manual labour or repetitive stress on your joints can cause a painful pinched nerve or a rotator cuff injury, but many people experience shoulder pain without an injury. Some shoulder conditions only get worse as people age, including arthritis, where the shoulder is the third most-affected joint after the knee and hip.

Shoulder pain usually gets better on its own. However, if you’re still experiencing pain after two weeks, you should see a specialist to diagnose the problem, as shoulder pain has a range of causes. Before seeking treatment, it can be helpful to ask the following questions:

Diagnosing shoulder pain

• Can you move your arm normally?
• Does it feel like your shoulder could pop out of the socket?
• Are you strong enough to perform day-to-day tasks, or does your shoulder feel like it’s going to give way?

If you can’t move your shoulder at all, you feel numbness in your hand or arm, or you experience sudden swelling, you should see a doctor immediately.

What causes shoulder pain?

The common causes of shoulder pain typically fall into one of five categories: physical injury, mechanical problems, inflammation, degeneration, and nerve irritation.

Physical injury

Dislocation: A dislocated or separated shoulder happens when the shoulder is pulled back or rotated too far, causing the top of your arm to pop out of its socket. This can cause sudden pain, weakness, swelling, numbness and bruising.

Fracture: Breaking your clavicle (collarbone) or humerus (the upper arm bone closest to your shoulder) can cause severe shoulder pain and bruising. If you’ve broken your collarbone, you might find it very difficult or impossible to lift your arm, and your shoulder may sag.

Mechanical problems

Shoulder instability: Because the shoulder is so heavily used, the lining of the joints can become stretched or torn, causing it to lose stability. Symptoms of shoulder instability include a tingling, numb or weak feeling, and a clicking or locking sensation. A dislocated shoulder is a type of instability, but this term can also be used to describe the shoulder joint moving more than it should (subluxation) and weakness of the rotator cuff muscles, which leads to an imbalance in the shoulder.

Inflammation

Arthritis: Unlike suffering shoulder pain after trauma, shoulder arthritis often has no direct cause. Damage generally occurs over time, and pain gradually gets worse. Depending on the type of arthritis, this can be caused by the joint degenerating over time (osteoarthritis) or the immune system attacking the lining of the joints (rheumatoid arthritis).

Bursitis: In the shoulder, fluid-filled sacs called bursa cushion your joints and protect the tendons. However, these can get swollen and irritated, causing bursitis. Bursitis can restrict movement due to inflammation and cause shoulder pain when the tendons are pinched between the bones.

Degeneration

Rotator cuff tear: The rotator cuff is a group of muscles and tendons in your shoulder that enable you to lift your arm and rotate it above your head. 

A tear often happens after a sports injury or doing tasks that require you to lift your arm, such as cleaning or painting, but it can also occur from routine wear and tear. This tear may be partial, where one of the muscles is damaged, or a complete tear that pulls the tendon off the bone. The most common symptoms are having trouble raising your arm, feeling shoulder pain when you move or lie on it, weakness and clicking or popping.

Nerve irritation

Shoulder impingement: This is a common cause of shoulder pain where the tendon rubs against nearby tissue and bone as you move your arm. A tell-tale sign of impingement is pain in the top and outer side of your shoulder that’s worse when you lift your arm above your head.

An impinging shoulder will not usually feel stiff. If it does, you likely have a frozen shoulder, which is characterised by ongoing stiffness that may last for months or even years.

What shoulder pain treatment is available?

If you have shoulder pain, our private orthopaedic Consultants can examine your shoulder and put together a tailored treatment plan to help you manage your symptoms.

After a physical examination, you may be sent for x-rays, an ultrasound, a CT scan or an MRI to establish a precise diagnosis. In rare cases, you may need keyhole surgery to detect the underlying cause.

The results of your examination, including the type of shoulder pain you have and how it was caused, will determine your treatment, which may include anti-inflammatory medication to ease pain and swelling and gentle exercises to improve mobility.

One of the worst things you can do if you have shoulder pain is to stop using your shoulder entirely. Instead, you should do gentle exercises such as shoulder stretches, which will help strengthen the muscle and improve flexibility. However, exercising incorrectly can worsen your shoulder pain, so it’s vital to watch your form and stop if the pain becomes severe. If you opt for treatment at our hospital in London, our private physiotherapists will tailor exercises to you and show you how to do them correctly at home.

Shoulder pain surgery

In some cases, you may need surgery to alleviate your shoulder pain, especially if it’s severe and significantly impacts your mobility and quality of life.

If you’ve broken your collarbone, for example, you may be able to leave it to heal naturally whilst wearing a sling to support your arm and hold the bones together. However, if the break has pierced the skin or the bones are overlapping, you may need a procedure to fix the break.

Shoulder surgery is more common in people with severe arthritis, and you have several options.

Shoulder arthroscopy

An arthroscopy is a form of keyhole surgery. As it’s a minimally invasive procedure, you’ll be allowed to go home the same day. This surgery involves inserting an arthroscope (a thin tube with a camera attached) into the shoulder via a small incision. It’s typically used to diagnose shoulder pain, but it can also help treat shoulder problems by tightening the ligaments to prevent dislocation or removing bone to allow more space for the rotator cuff tendons to move.

An arthroscopy can relieve shoulder arthritis symptoms but won’t stop them entirely.

Shoulder joint replacement

A shoulder replacement (arthroplasty) is the most common shoulder pain treatment for people with severe arthritis.

Like a hip or knee replacement, it involves removing the arthritic joint surfaces and replacing them with a metal or plastic implant. The type of replacement you need will depend on the type of arthritis (inflammatory, osteoarthritis or cuff tear) that you have.

The entire operation will take around two hours, and as it’s major surgery, you’ll need to stay in hospital for a couple of days after your operation.

It can take up to six months before you feel the full benefit of a shoulder replacement, but once fully recovered, many people find that their shoulder pain is completely gone and experience improved motion and shoulder function.
If you have shoulder pain and want to find out what’s causing it, book an appointment with our world-leading shoulder specialists and take the first step towards getting shoulder pain treatment that works for you.